Articulated tool positioner and system employing same

ABSTRACT

A laparoscopic surgical apparatus for performing a surgical procedure through a single incision in a patient&#39;s body includes a gross positioning arm supported on a moveable platform, the gross positioner including a head; at least one articulated tool positioning apparatus coupled via a tool controller to an underside of the head, the articulated tool positioning apparatus being configured to receive a tool for performing surgical operations, the tool controller being actuated by the head to cause movements of the articulated tool positioning apparatus for performing surgical operations; and wherein the gross positioner is configured to permit the head to be positioned to facilitate insertion of the articulated tool positioning apparatus through the incision into the patient&#39;s body.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Continuation Application of U.S. patentapplication Ser. No. 16/185,788, filed on Nov. 9, 2018, which is aContinuation Application of U.S. patent application Ser. No. 14/899,768,filed on Dec. 18, 2015 (now U.S. Pat. No. 10,278,683, which is a U.S.National Stage Application filed under 35 U.S.C. § 371(a) ofInternational Patent Application No. PCT/CA2013/001076, filed Dec. 20,2013, which claims the benefit to U.S. Provisional Patent ApplicationNo. 61/837,112, filed Jun. 19, 2013, the entire disclosure of each ofwhich is incorporated by reference herein.

BACKGROUND OF THE INVENTION 1. Field of Invention

This invention relates to robotic manipulators and more particularly toan articulated tool positioner with an example of a use of thearticulated tool positioner for laparoscopic surgery.

2. Related Art

Articulating surgical systems for laparoscopic surgery are gainingacceptance. Various systems exist including a system described in USPublication No. 2012/0253131 A1 published Oct. 4, 2012 to Malkowski etal.

Malkowski et al. describe a surgical system that includes one or morearms defining a passageway therethrough. The arm includes a proximalportion configured for positioning externally of a patient's body and adistal portion configured for positioning within an internal bodycavity. The distal portion includes first and second articulatablesegments spaced apart from one another and capable of independentarticulation between a substantially straight configuration and anarticulated configuration. A first articulation assembly is coupled tothe proximal portion of the one arm and is transitionable between afirst state and a second state for articulating the first articulatablesegment between the substantially straight configuration and thearticulated configuration. A second articulation assembly is coupled tothe proximal portion of the arm and is configured to move between aplurality of positions for articulating the second articulatable segmentbetween the substantially straight configuration and the articulatedconfiguration. Links forming articulable segments of the articulationassemblies are biased by springs into a substantially straight positionand cables are tensioned and untensioned to selectively pull on parts ofthe first and second articulation assemblies such that neutrality oftension between opposed internal cables is lost and this moves the armbetween the plurality of positions.

The arrangement described by Malkowski et al. could be complicated toassemble due to the springs in the links and is likely to requirecareful manipulation by an operator who must be mindful to counteractthe bias exerted by the springs to avoid undesired straightening of thearticulable segments.

SUMMARY

The present invention provides an alternative articulated toolpositioning apparatus that avoids the need for springs biasingarticulated segments into a straight position through the use of cablescapable of tension and compression connecting terminating membersbetween articulating links, thereby supporting both pushing and pullingon the cables and providing for simpler assembly.

In accordance with one aspect of the invention, there is provided anarticulated tool positioning apparatus. The apparatus includes a basemember, an intermediate member, an end member and a first tool holderarranged in succession, each of the base member, intermediate member,end member and tool holder having a respective central opening. Theapparatus further includes a first plurality of coupled guides betweenthe base member and the intermediate member at least one of the firstplurality of coupled guides is coupled to the base member and at leastone of the first plurality of coupled guides is coupled to theintermediate member. Each coupled guide of the first plurality ofcoupled guides has a respective central opening. The apparatus furtherincludes a second plurality of coupled guides between the intermediatemember and the end member. At least one of the second plurality ofcoupled guides is coupled to the intermediate member and at least one ofthe second plurality of coupled guides is coupled to the end member.Each coupled guide of the second plurality of coupled guides also has arespective central opening. The apparatus further includes a thirdplurality of coupled guides between the end member and the tool holder.At least one of the third plurality of coupled guides is coupled to theend member and at least one of the third plurality of coupled guides iscoupled to the tool holder. Each coupled guide of the third plurality ofcoupled guides also has a respective central opening. The apparatusfurther includes first guide openings in the base member andcorresponding first guide openings in each coupled guide of the firstplurality of coupled guides. A first plurality of flexible control linksdisposed in parallel spaced apart relation extend through respectiveopenings of the first guide openings in the base member and throughrespective openings of the corresponding first guide openings in thefirst plurality of coupled guides. Each of the first plurality offlexible control links has respective first end portions connected tothe intermediate member and respective second end portions extendingaway from the base member.

The apparatus further includes second guide openings in the intermediatemember and corresponding second guide openings in each coupled guide ofthe first and second pluralities of coupled guides. The apparatusfurther includes a second plurality of flexible control links disposedin parallel spaced apart relation, each having a first end connected tothe end member, a second end connected to at least one of the basemember and an object spaced apart from the base member. Each of thesecond flexible control links includes an intermediate portion betweenthe first and second ends. Each intermediate portion extends through arespective second guide opening in the intermediate member and throughrespective second guide openings in each guide of the first and secondpluralities of coupled guides.

The apparatus further includes third guide opening in the base memberand in each coupled guide of the first plurality of coupled guides andin the intermediate member and in each coupled guide of the secondplurality of coupled guides and in the end member and in each coupledguide of the third plurality of coupled guides.

The apparatus further includes a third plurality of flexible controllinks disposed in parallel spaced apart relation and extending throughrespective third guide openings in the base member, in each coupledguide of the first plurality of coupled guides through respective thirdguide openings, in the intermediate member through respective thirdguide openings, in each coupled guide of the second plurality of coupledguides through respective third guide openings, in the end member andthrough respective third guide openings in each coupled guide of thethird plurality of coupled guides. Each flexible control link of thethird plurality of flexible control links has a first end connected tothe tool holder and a second end extending away from the base member.

Pushing or pulling control links of the first plurality of control linkscauses the base member, the first plurality of coupled guides, theintermediate member, the second plurality of coupled guides and the endmember to selectively define a continuous curve. The second plurality ofcontrol links causes the end member to maintain an orientation generallythe same as the base member, when any of the first or third flexiblecontrol links is pushed or pulled. Pushing or pulling control links ofthe third plurality of control links causes the tool holder to beselectively moved into any of a plurality of orientations, such that thethird plurality of coupled guides between the end member and the toolholder defines a continuous curve from the end member to the toolholder.

The first, second and third pluralities of flexible control links mayinclude wires capable of experiencing about 200N of tension andcompression without yielding and up to about 2% to 4% strain.

The wires may be comprised of a metal alloy of nickel and titaniumhaving shape memory and superelasticity.

The second plurality of control links may include wires having a commonstiffness.

The base member, the intermediate member, the end member, the first toolholder and the coupled guides of the first, second and third pluralitiesof coupled guides may each have a generally circular cylindrical outersurface portion, and each the generally circular cylindrical outersurface portion may have a common diameter.

The base member, the intermediate member, the end member, the first toolholder and the coupled guides of the first, second and third pluralitiesof coupled guides may each have generally annular segments. At least oneannular segment of the base member and at least one annular segment ofeach coupled guide of the first plurality of coupled guides may have thefirst guide openings. At least one annular segment of each coupled guideof the first and second pluralities of coupled guides and at least oneannular segment of the intermediate member may have the second guideopenings, and at least one annular segment of each of the base member,the intermediate member, the end member, and each coupled guide of thefirst, second and third pluralities of coupled guides may have the thirdguide openings.

Each of the annular segments of the coupled guides of the firstplurality of coupled guides may have opposite faces disposed at acuteangles to an axis of the central opening in the coupled guide.

Each of the annular segments of the second plurality of coupled guidesmay have opposite faces disposed at acute angles to an axis of thecentral opening in the coupled guide.

Each of the annular segments of the third plurality of coupled guidesmay have opposite faces disposed at acute angles to an axis of thecentral opening in the coupled guide.

The opposite faces of annular segments of the coupled guides of thefirst and second pluralities of coupled guides may be disposed at afirst acute angle to the axis and the opposite faces of annular segmentsof the coupled guides of the third plurality of the coupled guides maybe disposed at a second acute angle to the axis, the second acute anglemay be different from the first acute angle.

The second acute angle may be greater than the first acute angle.

Adjacent pairs of coupled guides of the first, second and thirdpluralities of coupled guides may be coupled by at least one projectionon one guide of the pair and a receptacle for receiving the projectionon the other guide of the pair.

Each of the coupled guides of the first, second and third pluralities ofcoupled guides may have an axially extending projection having atruncated spherical portion and an axially aligned socket for receivingan axially extending projection of an adjacent coupled guide to permitadjacent coupled guides to spherically pivot relative to each other. Thecentral opening of the coupled guide may have a first terminus on theprojection and a second terminus in the socket so that central openingsof adjacent coupled guides are in communication with each other so as todefine a central channel operable to receive a portion of a tool held bythe tool holder.

The apparatus may further include a first support conduit having firstand second open ends, and the base may be connected to the first openend of the support conduit to support the base and the second endportions of the first and third control links may extend through thefirst support conduit to extend out of the second open end of the firstsupport conduit.

In accordance with another aspect of the invention, there is provided atool assembly comprising the apparatus described above and furtherincluding a first tool. The first tool may include a first end effector,a first coupler for coupling the first end effector to the first toolholder, the tool may further include a first flexible shaft portionhaving a length approximately the same as a length defined between thebase member and the tool holder, and a first rigid shaft portion havinga length approximately equal to a length of the first support conduit.The tool may further include a first tool control link having a firstend connected to the first end effector and a second end extending fromthe first rigid shaft portion. The first rigid shaft portion may bereceived in the central opening of the first tool holder and may extendthrough the central openings in the third plurality of coupled guidesthrough the central opening in the end member, through the centralopenings in the second plurality of coupled guides, through the centralopening in the intermediate member, the central openings in the firstplurality of coupled guides, and through the central openings in thebase member and the first support conduit such that the first flexibleshaft portion is coaxial with the tool positioning apparatus and suchthat the first rigid shaft portion is generally coaxial with the firstsupport conduit and such that the second end of the first tool controllink extends from the second end portion of the first support conduit.

In accordance with another aspect of the invention, there is provided atool controller assembly including the tool assembly described above andfurther including a first control mount. The first support conduit ofthe tool positioning apparatus may be connected to the first controlmount such that the first control mount may be on a first side of afirst longitudinal axis of the first support conduit. The first controlmount may have a first plurality of actuators connected to respectiveflexible control links of the first and third pluralities of flexiblecontrol links of the first tool positioning apparatus, for selectivelypushing and pulling on the second end portions of the respectiveflexible control links to cause the base member, the first plurality ofcoupled guides, the intermediate member, the second plurality of coupledguides and the end member to selectively define a continuous curve andto cause the tool holder to be selectively moved into any of a pluralityof orientations, such that the third plurality of coupled guides betweenthe end member and the first tool holder apparatus may define acontinuous curve from the end member to the first tool holder. The firstcontrol mount may include a first tool actuator connected to the firsttool control link of the first tool, for selectively pushing and pullingon the second end portion of the first tool control link to effectoperation of the end effector.

Each actuator of the first plurality of actuators and the first toolactuator may include a respective rotatable spool portion to which arespective control link is connected to permit a portion of therespective control link to be taken up or payed out from the spoolportion in response to corresponding rotation of the spool portion, anda respective driver for selectively rotating the spool portion in firstand second opposite directions. The respective control link may bepulled when the spool portion is rotated in the first direction to takeup the portion of the respective control link and the respective controllink may be pushed when the spool portion is rotated in the seconddirection to pay out the portion of the respective control link.

Each driver may include a gear segment.

The first control mount may have a first mounting surface and each gearsegment may have a portion that projects beyond the first mountingsurface to engage a corresponding drive gear on a first tool controllermount.

In accordance with another aspect of the invention, there is provided atool controller mount including a first tool controller assembly asdescribed above mounting interface for holding a first tool controllerand may further include a first plurality of drive gears for engagingrespective gear segments on the first tool controller assembly.

The drive gears of the first plurality of drive gears may includerespective linear gear racks operably configured to slide linearly inparallel spaced apart relation.

The apparatus may include a first plurality of linear actuatorsconnected to respective linear gear racks for sliding the linear gearracks linearly to impart movement to corresponding gears of the secondplurality of drive gears.

The apparatus may include a second tool controller mounting interfacecomprising a second plurality of drive gears for engaging respectivegear segments on a second tool controller similar to the first toolcontroller described above.

The drive gears of the second plurality of drive gears may includerespective linear gear racks operably configured to slide linearly inparallel spaced apart relation.

The apparatus may include a second plurality of actuators connected torespective linear gear racks for sliding the linear gear racks linearlyto impart movement to corresponding drive gears of the second pluralityof drive gears.

In accordance with another aspect of the invention, there is provided atool supervisory apparatus including a positioning tube positioned toreceive at least one support conduit of a tool controller assembly asdescribed above. The positioning tube may have a length approximatelythe same as or less than a length of the support conduit so that a toolholder supported by the support conduit extends from a distal end of thepositioning tube. The tool supervisory apparatus further includes acamera holder in a position off an axis of the positioning tube suchthat the camera may be directed toward an end effector of a tool held bythe tool holder to facilitate visual monitoring of movement of the endeffector.

The camera holder may include the tool holder. The support conduit ofthe camera holder may extend inside the positioning tube and a toolpositioner of the camera holder may extend from the distal end of thepositioning tube and may be operably configured to hold and position thecamera in a position off the second axis. The second axis may begenerally perpendicular to the longitudinal axis of the support conduit.

BRIEF DESCRIPTION OF THE DRAWINGS

In drawings which illustrate embodiments of the invention,

FIG. 1 is a perspective view of an articulated tool positioningapparatus according to a first embodiment of the invention;

FIG. 2 is a perspective view of a distal end of a base member of theapparatus shown in FIG. 1 ;

FIG. 3 is a distal end view of the base member shown in FIG. 2 ;

FIG. 4 is a perspective view of a proximal side of a coupled guide ofthe apparatus shown in FIG. 1 ;

FIG. 5 is a top view of the coupled guide shown in FIG. 1 ;

FIG. 6 is an exploded view of two coupled guides of the apparatus shownin FIG. 1 , including the coupled guide shown in FIGS. 4 and 5 ;

FIG. 7 is a side view of the coupled guides of FIG. 6 shown engaged;

FIG. 8 is a perspective view of the apparatus shown in FIG. 1illustrating a bended configuration of the tool positioner shown in FIG.1 ;

FIG. 9 is a perspective view of a proximal face of an intermediatemember of the apparatus shown in FIG. 1 ;

FIG. 10 is a perspective view of a distal face of the intermediatemember shown in FIG. 9 ;

FIG. 11 is a perspective view of a proximal side of an end member of theapparatus shown in FIG. 1 ;

FIG. 12 is a perspective view of a distal side of the side member shownin

FIG. 11 ;

FIG. 13 is a perspective view of a proximal side of a tool holder of theapparatus shown in FIG. 1 ;

FIG. 14 is a perspective view of a distal side of the tool holder shownin

FIG. 13 ;

FIG. 15 is a side view of a tool apparatus for use with the toolpositioner shown in FIG. 1 ;

FIG. 16 is a perspective view of a tool assembly comprised of theapparatus shown in FIG. 1 with the tool apparatus shown in FIG. 15connected thereto;

FIG. 17 is a perspective view of a tool controller shown connected tothe tool assembly shown in FIG. 16 ;

FIG. 18 is a perspective view of a laparoscopic surgical apparatusemploying the device shown in FIG. 17 ;

FIG. 19 is a side view of a head of the apparatus shown in FIG. 18 and acoupler operable to be coupled to the head;

FIG. 20 is a side view of the head and coupler of FIG. 19 with thecoupler connected to the head;

FIG. 21 is a side view of the coupler connected to the head of FIGS. 19and 20 with a sterile cover connected to the coupler draped over thehead and nearby components;

FIG. 22 is a side view of the head and coupler of FIGS. 19-21 and acamera/delivery tube assembly operable to be coupled to the coupler;

FIG. 23 is a detailed view of the camera/delivery tube assembly shown inFIG. 22 ;

FIG. 24 is a side view of the camera/delivery tube assembly shown inFIG. 23 coupled to the coupler shown in FIGS. 19-22 ;

FIG. 25 is a side view of the camera/delivery tube assembly coupled tothe coupler and a tool positioning device of the type shown in FIG. 17being engaged therewith;

FIG. 26 is a perspective view from below of the tool controller of FIG.17 connected to the coupler of FIGS. 19-22 with a tube associated withthe tool positioning device inserted in the delivery tube shown in FIG.23 ;

FIG. 27 is a side view of the delivery tube of FIG. 23 with a first tubesupporting the tool positioner of FIG. 1 extending therethrough;

FIG. 28 is a side view of the apparatus of FIG. 27 further including asecond tool support tube supporting a second tool positioner extendingthrough the delivery tube of FIG. 23 ;

FIG. 29 is a side view of a laparoscopic surgical apparatus employingthe apparatuses described in FIGS. 1-28 ; and

FIG. 30 is a perspective view of a surgeon's work-station forcontrolling the apparatus shown in FIG. 29 .

FIG. 31 is a perspective view from below of two tool controllers of thetype shown in FIG. 17 on a coupler according to an alternativeembodiment of the invention;

FIG. 32 is a fragmented side view of first and second articulated toolpositioning apparatuses extending at different distances from an end ofa delivery tube of the coupler shown in FIG. 31 , when first and secondtool controllers thereon are disposed at different linear distances fromthe delivery tube.

DETAILED DESCRIPTION

Referring to FIG. 1 , an articulated tool positioning apparatusaccording to a first embodiment of the invention is shown generally at20. In this embodiment, the apparatus 20 includes a base member 22, anintermediate member 24, an end member 26 and a first tool holder 28arranged in succession as shown in FIG. 1 . The base member 22 may beconsidered to be in a proximal position while the tool holder may beconsidered to be in a distal position. Thus, the base member 22,intermediate member 24, end member 26 and first tool holder 28 arearranged in succession from a proximal position to a distal position.

The apparatus 20 further includes a first plurality 30 of coupledguides, disposed between the base member 22 and the intermediate member24. At least one (32) of the first plurality 30 of coupled guides iscoupled to the base member 22 and another one (34) of the firstplurality 30 of coupled guides is coupled to the intermediate member 24.Each of the coupled guides of the first plurality 30 is coupled to anadjacent guide or to the base member 22 or intermediate member 24.

The tool positioning apparatus 20 further includes a second plurality 36of coupled guides between the intermediate member 24 and the end member26. At least one (38) of the second plurality 36 of coupled guides iscoupled to the intermediate member 24 and another one (40) of the secondplurality 36 of coupled guides is coupled to the end member 26. Each ofthe coupled guides of the second plurality 36 of coupled guides is thusconnected to an adjacent guide of the second plurality or to theintermediate member 24 or the end member 26.

The apparatus 20 further includes a third plurality 42 of coupled guidesbetween the end member 26 and the tool holder 28. At least one (44) ofthe third plurality 42 of coupled guides is coupled to the end member 26and another one (46) of the third plurality 42 of coupled guides iscoupled to the tool holder 28. Each of the coupled guides of the thirdplurality 42 is thus connected to an adjacent coupled guide of the thirdplurality or to the end member 26 or to the tool holder 28.

Referring to FIG. 2 , the base member 22 has a generally circularcylindrical first outer surface portion 50 having a first diameter and asecond coaxial, generally circular cylindrical surface portion 52 havinga second diameter smaller than the first diameter. The surface portion52 having the smaller diameter facilitates connection to an adjacentsupport conduit as will be described below.

Referring back to FIG. 1 , the intermediate member 24 also has agenerally circular cylindrical outer surface portion 54, the end member26 has a similar outer surface portion 56 and the tool holder 28 has asimilar outer surface portion 58 all having a diameter the same as thediameter of the first outer surface portion 50 of the base member 22. Inaddition, each coupled guide of the first, second, and third pluralities30, 36 and 42 of coupled guides has an outer circular cylindricalsurface portion, exemplary ones of which are shown at 60, 62 and 64respectively. Thus, the tool positioning apparatus 20 has a plurality ofgenerally coaxially aligned components all having outer surfaces of thesame common diameter.

Referring to FIGS. 2 and 3 , the base member 22 has a generallycylindrical body having a distal-facing end face 66 having an axiallyextending projection 68 with a truncated spherical portion 70 throughwhich a central opening 72 is formed. The central opening 72 extendsaxially through the entire base member 22. The distal-facing end face 66also has receptacles 74 and 76 disposed diametrically opposite eachother and extending into the outer surface portion 50 to receivecorresponding projections on coupled guide 32 shown in FIG. 1 .

Referring to FIGS. 1 and 2 as will be explained below, the truncatedspherical portion 70 and the receptacles 74 and 76 serve to couple thebase member 22 to coupled guide 32 of the first plurality 30 of coupledguides.

Referring back to FIGS. 2 and 3 , the distal-facing end face 66 furtherhas a first plurality of guide openings 80, 82, 84, 86 through which afirst plurality of flexible control links 88, 90, 92, 94 connected tothe intermediate member 24 extend through the base member 22.

In the embodiment shown, the distal-facing end face 66 also has aplurality of receptacles 96, 98, 100 and 102 to which ends of respectiveones of a second plurality of flexible control links 104, 106, 108, 110extending between the base member 22 and the end member 26 areconnected. In an alternate embodiment, the plurality of receptacles 96,98, 100 and 102 may instead be a plurality of openings extending throughthe base member 22, allowing the second plurality of flexible controllinks 104, 106, 108, 110 to extend through and away from the base member22. In this alternate embodiment, the ends of respective ones of thesecond plurality of flexible control links 104, 106, 108, 110 areconnected to a fixed object (not shown), spaced apart from the basemember 22. The fixed object may be a tool controller of the typedescribed at 602 in FIG. 17 , suitably modified such that the ends ofrespective ones of the second plurality of flexible control links 104,106, 108, 110 are connected to the base plate 612 thereof, for example.

The distal-facing end face 66 also has a third plurality of guideopenings 112, 114, 116, 118 through which respective ones of a thirdplurality of flexible control links 120, 122, 124, 126 connected to thetool holder 28 extend through the base member 22.

Each link of the first, second and third pluralities of flexible controllinks may be a single nitinol wire capable of about 200N in tension orcompression without permanent deformation and capable of experiencing upto about 4% strain. Nitinol is an alloy of nickel and titanium havingshape memory and superelasticity and its ability to support both tensionand compression allows the links to be selectively pushed or pulled withsimilar forces without permanent deformation, which provides for precisecontrol of the flexible control links, actuation redundancy andincreased structural stiffness. Accordingly, only two flexible controllinks are required in each of the first, second, and third plurality offlexible control links to achieve a full range of movement of the toolholder relative to the base member 22.

Referring back to FIG. 1 , the first plurality 30 of coupled guides areconfigured to cause the tool positioning apparatus 20 to have a flexiblesection while at the same time maintaining the first, second and thirdflexible control links 88, 90, 92, 94, 104, 106, 108, 110, 120, 122,124, 126 in a pre-defined spaced apart relation relative to each other.Generally, the individual flexible control links in each plurality offlexible control links are spaced apart angularly on a circle such thatthe flexible control links of a given plurality are spaced apart fromeach other as far as possible. This reduces and balances actuationloads, increases the stiffness of the flexible section and reducesbacklash effects as the direction of force on the flexible control linksis changed in response to pushing and pulling of the flexible controllinks.

In the embodiment shown, the first plurality 30 of coupled guidesincludes fourteen coupled guides. Coupled guide 32 is an exemplarycoupled guide of the first plurality 30 and is shown in greater detailin FIG. 4 .

Referring to FIG. 4 , coupled guide 32 has a body having proximal anddistal-facing sides 130 and 132 and first and second annular segments134 and 136.

The proximal facing side 130 has first and second projections 138 and140 disposed diametrically opposite each other, the annular segments 134and 136 being defined between the projections 138 and 140. Theprojections 138 and 140 are operably shaped to be received inreceptacles 74 and 76 on the base member 22. The annular segments 134and 136 have receptacles 142 and 144 disposed diametrically oppositeeach other and disposed in positions angularly offset by 90 degrees fromthe first and second projections 138 and 140.

The proximal facing side 130 also has a socket 146 having a shapecomplementary to the truncated spherical shape of the projection 68 onthe base member 22 to receive that projection therein. The projection 68on the base member 22 and the socket 146 on the coupled guide 32 allowthe coupled guide to pivot about the projection 68 and such pivoting isconstrained in a vertical or pitch direction (e.g. up and down in theplane of the drawing, FIG. 7 ) by the projections 138 and 140 receivedin the receptacles 74 and 76 on the distal facing end face 66 of thebase member 22.

The socket 146 terminates in a cylindrical wall 148 disposed in atruncated spherical projection 150 seen in FIG. 5 extending from thedistal facing side 132. The cylindrical wall 148 defines central opening152 in the body of the coupled guide 32.

Referring back to FIG. 4 , the annular segments 134 and 136 have a firstplurality of guide openings 160, 162, 164 and 166 which are generallyaligned with first guide openings 80, 82, 84 and 86 in the base member22 to guide the first plurality of flexible control links (88, 90, 92and 94) through the coupled guide 32.

The annular segments 134 and 136 also have a second plurality of guideopenings 168, 170, 172 and 174 which are generally aligned with thesecond receptacles 96, 98, 100 and 102 (shown in FIGS. 2 and 3 ) in thebase member 22 to guide the second plurality of flexible control links(104, 106, 108 and 110 shown in FIGS. 2 and 3 ) through the coupledguide 32.

The annular segments 134 and 136 also have a third plurality of guideopenings 176, 178, 180 and 182 which are generally aligned with thethird plurality of guide openings 112, 114, 116, 118 in the base member22 to guide the third plurality of flexible control links (120, 122,124, 126) through the coupled guide 32.

Referring to FIG. 5 , the coupled guide 32 is shown from above lookingin the direction of arrow 189 in FIG. 1 . Annular segments 134 and 136have portions 190 and 192 respectively having angled surfaces 194 and196 that form an obtuse angle in a horizontal plane intersecting theaxis 200 of the coupled guide 32. These surfaces 194 and 196 extendsymmetrically at about a 6 degree angle to a first plane 198perpendicular to the axis 200 of the coupled guide 32.

Referring back to FIG. 4 , the coupled guide 32 also has proximal facingsurfaces 202 and 204 defined between the receptacles 142 and 144 thatform an obtuse angle in a vertical plane intersecting the axis 200 ofthe coupled guide 32. This can be seen as a slight incline in proximalfacing surface 202 in FIG. 5 , which forms an angle of about 6 degreeswith a second plane 199 perpendicular to the axis 200 of the coupledguide 32 and provides for rotation of up to 6 degrees in the pitchdirection, relative to the base member 22.

Referring to FIG. 6 , the distal facing side 132 of the coupled guide 32is shown along with an immediately distally-adjacent coupled guide 60.Immediately distally adjacent coupled guide 60 is similar to coupledguide 32 in that it includes annular segments having the same firstplurality of guide openings 160, 162, 164 and 166, the same secondplurality of guide openings 168, 170, 172 and 174 and the same thirdplurality of guide openings 176, 178, 180 and 182. It also has atruncated spherical projection 207 having a bore 209. It also has asocket (not shown) like socket 146 in the coupled guide 32, in itsproximal facing side.

The immediately adjacent coupled guide 60 is different than the coupledguide 32 in that it has receptacles 210 and 212 where the projections138 and 140 of the coupled guide 32 are located and has projections,only one of which is shown at 214, where the receptacles 142 and 144 ofthe coupled guide 32 are located.

In addition, referring to FIG. 7 , the immediately adjacent coupledguide 60 has annular segments 216 and 218 extending between thereceptacles 210 and 212 having portions 220 and 222 having distal facingsurfaces 224 and 226 that form an obtuse angle in a vertical planeintersecting the axis of the immediately distally adjacent coupled guide60 and proximal facing surfaces only one of which is seen at 227 in FIG.7 , extending between the receptacles 210 and 212 that form an obtuseangle in a horizontal plane intersecting the axis 230. The distal facingsurfaces 224 and 226 are disposed at about a 6 degree angle to a firstvertical plane 228 intersecting the axis 230 and perpendicular theretoand the proximal facing surfaces, only one of which is shown at 227, aredisposed at about a 6 degree angle to a second vertical plane 229intersecting the axis 230.

Still referring to FIG. 7 , it can be seen that the coupled guide 32 andimmediately distally adjacent coupled guide 60 are coupled together toform a pair of coupled guides by receiving the projection 150 of thecoupled guide 32 in the socket (not shown) of the immediately distallyadjacent coupled guide 60 and receiving the proximal facing projectionsof the immediately distally adjacent coupled guide 60, only one of whichis shown at 214, in corresponding receptacles, only one of which isshown at 144 of the coupled guide 32. The projection 150 and socketarrangement provides for pivoting in any direction and the proximallyfacing projections 214 received in corresponding receptacles 144 preventtorsional movement about the axis 230, of the immediately distallyadjacent coupled guide 60 relative to the coupled guide 32 and limitrelative rotational movement to what is shown as a horizontal or yawdirection, i.e. into and out of the plane of the page. The angledsurface 227 of the immediately distally adjacent coupled guide 60 facesangled surface 196 of the coupled guide 32 and this provides clearancefor relative movement pivoting about the truncated spherical projection150 of up to a total of 12 degrees in the yaw direction.

Similarly, the angled distal facing surfaces 224 and 226 on theimmediately distally adjacent coupled guide 60 will face proximallyfacing surfaces like surfaces 202 and 204 on a next distally adjacentcoupled guide 205 and this will provide for relative rotational movementbetween the immediately adjacent coupled guide 60 and the next distallyadjacent coupled guide 205 of up to 12 degrees in the pitch direction.Thus each pair of coupled guides provides for limited defined movementin the pitch and yaw directions. More generally, every odd numberedcoupled guide is operable to rotate in a vertical plane (pitchdirection) and every even numbered coupled guide is operable to rotatein a horizontal plane (yaw direction).

Referring back to FIG. 1 , in the embodiment shown the first plurality30 of coupled guides includes seven pairs of coupled guides whichenables the first plurality of coupled guides to have pitch and yaw bendcomponents sufficient to define a continuous arc extending through up to90 degrees. Thus, the intermediate member 24 can be positioned in anorientation in any direction relative to the axis of the base member 22up to an angle of about 90 degrees off the axis of the base member suchas shown in FIG. 8 .

Referring to FIG. 9 , the intermediate member 24 has a body havingproximal and distal facing sides 250 and 252. The proximal facing side250 has first and second annular segments 254 and 256 disposed betweenfirst and second projections 258 and 260 that project proximally towardthe first plurality 30 of coupled guides. These projections 258 and 260are received in receptacles like those shown at 210 and 212 in FIG. 6 inthe immediately adjacent coupled guide 34 of the first plurality 30 ofcoupled guides as seen in FIG. 1 . Referring back to FIG. 9 , theproximal facing side 250 has a socket 262 terminating in an annular wall264 defining a central opening 266 through the body. A projection likethe one shown at 207 in FIG. 6 of the immediately adjacent coupled guide32 of the first plurality 30 of coupled guides is operable to bereceived in the socket 262 and the projections 258 and 260 are receivedin receptacles similar to those shown at 210 and 212 in FIG. 6 of theimmediately adjacent coupled guide 34. This permits the immediatelyadjacent coupled guide 34 to pivot about the projection 207 in a pitchdirection.

The intermediate member 24 further includes first, second, third andfourth receptacles 270, 272, 274 and 276 disposed at locations alignedwith the first set of guide openings 160, 162, 164 and 166 respectivelyin the immediately adjacent coupled guide 34 to receive and hold ends ofthe first plurality of flexible control links 88, 90, 92 and 94respectively, extending through the first set of guide openings 160,162, 164 and 166 of the immediately adjacent coupled guide 34.

The proximal facing side 250 further includes a second plurality ofopenings 280, 282, 284 and 288 which extend entirely through theintermediate member 24 for guiding the second plurality of flexiblecontrol links 104, 106, 108 and 110 therethrough. In addition, theproximal facing side 250 includes a third plurality of guide openings290, 292, 294 and 296 that extend through the entire intermediate member24 for guiding the third plurality of flexible control links 120, 122,124, and 126 therethrough.

Referring to FIG. 10 , the intermediate member 24 further includes aprojection 300 projecting from the distal facing side 252 and has firstand second receptacles 302 and 304 diametrically opposed and disposed inthe outer surface portion 54 and terminating on an end face 306 of thedistal facing side 252. Referring back to FIG. 1 , the receptacles 302and 304 receive corresponding projections on the immediately adjacentcoupled guide 38 of the second plurality 36 of coupled guides. Thesecond plurality 36 of coupled guides is the same as the first pluralityof coupled guides, described above, in connection with FIGS. 4 through 7.

Referring to FIG. 11 , the end member 26 has a body having proximal anddistal facing sides 350 and 352. The proximal facing side 350 has firstand second annular segments 354 and 356 disposed between first andsecond projections 358 and 360 that project proximally toward the secondplurality 36 of coupled guides. These projections 358 and 360 arereceived in receptacles like those shown at 210 and 212 in FIG. 6 in theimmediately adjacent coupled guide 40 of the second plurality of coupledguides 36 as seen in FIG. 1 . Referring back to FIG. 11 , the proximalfacing side 350 has a socket 362 terminating in an annular wall 364defining a central opening 366 through the body. A projection like theone shown at 207 in FIG. 6 of the adjacent coupled guide 40 of thesecond plurality of coupled guides 36 is operable to be received in thesocket 362 and the projections 358 and 360 are received in receptaclessimilar to those shown at 210 and 212 in FIG. 6 of the immediatelyadjacent coupled guide 40. This permits the immediately adjacent coupledguide 40 to pivot about the projection (207) in a pitch direction.

The end member 26 further includes first, second, third and fourthreceptacles 370, 372, 374 and 376 disposed at locations aligned with thesecond set of guide openings 168, 170, 172 and 174 respectively in theadjacent coupled guide 40 to receive and hold ends of the secondplurality of flexible control links 104, 106, 108 and 110 respectively,extending through the second guide openings 168, 170, 172 and 174 of theimmediately adjacent coupled guide 40.

The proximal facing side 350 further includes a third plurality ofopenings 380, 382, 384 and 386 which extend entirely through the endmember 26 for guiding the third plurality of flexible control links 120,122, 124 and 126 therethrough.

Referring to FIG. 12 , the end member 26 further includes a projection400 projecting from the distal facing side 352 and has first and secondreceptacles 402 and 404 disposed in the outer surface portion 56 andterminating on a flat annular end face 406 of the distal facing side352. Referring back to FIG. 1 , the receptacles 402 and 404 receivecorresponding projections on the immediately adjacent coupled guide 44of the third plurality 42 of coupled guides.

The third plurality 42 of coupled guides includes coupled guides thesame as those shown in FIGS. 4 through 7 with the exception that thesurfaces 194 and 196 extend symmetrically at about an 8.5 degree angleto the first plane 198 perpendicular to the axis of the coupled guideand the proximal facing surfaces 202 and 204 form angles of about 8.5degrees with the second plane 199 perpendicular to the axis of thecoupled guide. With the angles of the indicated surfaces on the thirdplurality of coupled guides being slightly greater than the angles onthe first and second plurality of coupled guides, the third plurality ofcoupled guides can include fewer elements such as shown in thisembodiment where there are only about 10 coupled guides and enable theportion extending from the end member 26 to be bent in a tighter radiusthan the coupled guides of the first and second pluralities 30 and 36can be bent as shown in FIG. 8 .

Referring to FIGS. 13 and 14 , the tool holder 28 has a body havingproximal and distal facing sides 450 and 452. The proximal facing side450 has first and second annular segments 454 and 456 disposed betweenfirst and second projections 458 and 460 that project proximally towardthe third plurality 42 of coupled guides. These projections 458 and 460are received in receptacles like those shown at 210 and 212 in FIG. 6 inthe immediately adjacent coupled guide 46 of the third plurality 42 ofcoupled guides as seen in FIG. 1 . Referring back to FIG. 13 , theproximal facing side 450 has a socket 462 terminating in an annular wall464 defining a central bore 466 through the body. A projection like theone shown at 207 in FIG. 6 of the adjacent coupled guide 46 of the thirdplurality of coupled guides 42 is operable to be received in the socket462 and the projections 458 and 460 are received in receptacles similarto those shown at 210 and 212 in FIG. 6 of the immediately adjacentcoupled guide 46. This permits the immediately adjacent coupled guide 46to pivot about the projection 207 in a pitch direction.

The tool holder 28 further includes first, second, third and fourthreceptacles 470, 472, 474 and 476 disposed at locations aligned with thethird set of guide openings 176, 178, 180 and 182 respectively in theadjacent coupled guide 46 to receive and hold ends of the thirdplurality of flexible control links 120, 122, 124 and 126 respectively,extending through the second set of guide openings 176, 178, 180 and 182of the immediately adjacent coupled guide 46.

Referring to FIG. 14 , the tool holder 28 has a flat annular end face500 on the distal facing side 452 and the bore 466 is coterminous withthe annular end face 500. Aligned openings 502 and 504, are aligned on achord extending through the wall 464 and are operable to receive athreaded fastener, for example, for securing a tool in the tool holder28, so that the tool can rotate axially in the tool holder.

Referring to FIG. 15 , an exemplary tool for use in the tool holdershown in FIGS. 13 and 14 is shown generally at 550. In the embodimentshown, the tool 550 includes an end effector 552, which, in theembodiment shown includes a gripper having fixed and pivotal opposingjaws 554 and 556 extending from a base 558. Other tool arrangementscould alternatively be employed. For example, the tool may alternativelybe a cauterizing device, a suctions device, a retraction device or agrasping device. In the embodiment shown a flexible tool control link560 is connected to the pivotal jaw 556 and extends through an axialopening in the base 558 to open and close the pivotal jaw 554 on thefixed jaw 556 in response to linear movement of the flexible controllink 560.

The tool 550 further includes a coupler comprised of first and secondspaced apart cylinders 562 and 564 rigidly connected to the base 558 andhaving outer cylindrical surfaces 563 and 565 slightly smaller than adiameter of the bore 466 in the tool holder 28 so that the tool 550 canbe held snugly in the tool holder 28. A flexible conduit 566 having alength approximately equal to a distance between the tool holder 28 andthe base member 22 has a first end 568 connected to the cylinder 564 anda second end 570 connected to a first end 572 of a rigid conduit 574 bya crimp connector 576. The flexible tool control link 560 extendsthrough the cylinders 562 and 564, through the flexible conduit 566 andthrough the rigid conduit 574 and has a second end 578 that extendsoutwardly from a proximal end 580 of the rigid conduit 574. Accordingly,linear movement of the second end 578 of the flexible tool control link560 relative to the proximal end 580 of the rigid conduit 574 opens andcloses the pivotal jaw 556.

Referring to FIGS. 15 and 16 , the tool 550 is shown installed in thetool holder 28 whereby only the base 558 and jaws 554 and 556 projectdistally from the tool holder and the flexible conduit 566 extendsthrough the central openings 152 in the third plurality of coupledguides 42, the central opening 266 in the end member 26, the centralopenings 152 in the second plurality of coupled guides 36, the centralopening 266 in the intermediate member 24, and the central openings(152) in the first plurality 30 of coupled guides. The crimp connector576 is located in the central opening 72 in the base member 22 and isabout the same length as the base member and the rigid conduit 574extends outwardly from the base member in a proximal direction. The tool550 installed in the tool holder thus forms a tool assembly 600comprised of the tool 550 and the tool positioning apparatus 20.

Referring to FIG. 17 , the tool assembly 600 is connected to a toolcontroller 602 comprising a second rigid conduit 604 having a first end606 rigidly connected to the outer surface portion 52 of reduceddiameter of the base member 22 and having a second end 608 connected toa drive mechanism 610. The drive mechanism 610 includes a base plate 612having a conduit coupling 614 for rigidly connecting the second rigidconduit 604 to the base plate 612. In addition the drive mechanismincludes a rotational coupling 616 connected to the proximal end 580 ofthe rigid conduit 574 whereupon rotation of the rotational coupling 616causes a corresponding rotational movement of the rigid conduit 574about its axis. A rotational flexible control link 618 is connected tothe rotational coupling 616 and is routed to a rotational spool 620which is connected to a gear segment 622 such that when the gear segmentis rotated the rigid conduit 574 is rotated by a corresponding amount.Such rotation of the rigid conduit 574 rotates the tool 550 by acorresponding amount.

The first, third and tool flexible control links 88, 90, 92 and 94; 120,122, 124 and 126; and 560 extend through the interior of the secondrigid conduit 604 and emanate from the second end 608 of the secondrigid conduit 604. The drive mechanism 610 has a link guide showngenerally at 624 for guiding the tool control link 560 to a tool spool626 connected to a tool gear segment 628. The tool control link 560 iswound on the tool spool 626 such that rotation of the tool gear in afirst direction opens the end effector 552 of the tool 550 and rotationof the tool spool 626 in a second, opposite direction closes the endeffector.

Two of the third flexible control links in a horizontal plane at thetool holder 28 such as links 120 and 126 or links 122 and 124 are woundin opposite directions on a horizontal tool control spool 630 connectedto a horizontal tool control gear 632, such that rotation of thehorizontal tool control gear 632 in a first direction pulls on, say, aleft side link 120 or 122 while pushing on a corresponding right sidelink 126 or 124 and rotation of the horizontal tool control gear 632 ina second direction opposite to the first direction pushes on the leftside link 120 or 122 while pulling the corresponding right side link 126or 124. This has the effect of moving the tool holder 28 to the left orright.

Two of the third flexible control links in a vertical plane at the toolholder 28 such as links 120 and 122 or links 124 and 126, depending onwhich of these links are not already connected to the horizontal toolcontrol spool 630, are wound in opposite directions on a vertical toolcontrol spool 634 connected to a vertical tool control gear 636, suchthat rotation of the vertical tool control gear 636 in a first directionpulls on, say, an upper link 120 or 126 while pushing on a correspondinglower link 122 or 124 and rotation of the vertical control gear 636 in asecond direction opposite to the first direction pushes on the upperlink 120 or 122 while pulling the corresponding lower link 122 or 124.This has the effect of moving the tool holder 28 up or down.

Two of the first flexible control links in a horizontal plane at theintermediate member 24 such as links 88 and 94 or links 90 and 92 arewound in opposite directions on a horizontal s-curve control spool 638connected to a horizontal s-curve gear 640, such that rotation of thehorizontal s-curve control gear 640 in a first direction pulls on, say,a left side link 88 or 90 while pushing on a corresponding right sidelink 92 or 94 and rotation of the horizontal s-curve control gear 640 ina second direction opposite to the first direction pushes on the leftside link 88 or 90 while pulling the corresponding right side link 92 or94. This has the effect of moving the intermediate member 24 to the leftor right.

Two of the first flexible control links in a vertical plane at theintermediate member 24 such as links 88 and 90 or links 92 and 94,depending on which of these links are not already connected to thehorizontal s-curve control spool 638, are wound in opposite directionson a vertical s-curve control spool 642 connected to a vertical s-curvecontrol gear 644, such that rotation of the vertical s-curve controlgear 644 in a first direction pulls on, say, an upper link 88 or 94while pushing on a corresponding lower link 90 or 92 and rotation of thevertical s-curve control gear 644 in a second direction opposite to thefirst direction pushes on the upper link 88 or 94 while pulling thecorresponding lower link 90 or 92. This has the effect of moving theintermediate member 24 up or down.

While spools 626, 620, 630, 634, 638 and 642, and corresponding gearsegments 628, 622, 632, 636, 640 and 644 are arranged in a particularorder as depicted in FIG. 17 , the ordering is not important. Thus, forexample, spool 626 and corresponding gear segment 628 may be arrangedsuch that they are positioned between spool 620 and corresponding gearsegment 622, and spool 630 and corresponding gear segment 632.

The second flexible control links 104, 106, 108 and 110, being connectedbetween the base member 22 and the end member 26, act as a kind ofparallelogram in two dimensions, tending to keep the end member 26 atthe same orientation as the base member 22. The first plurality offlexible control links 88, 90, 92 and 94 move the intermediate member 24but parallelogram effect of the second plurality of control links tendsto keep the end member 26 at the same orientation as the base member 22.Similarly, the third plurality of control links 120, 122, 124 and 126moves the tool holder 28, but again the end member 26 is held under theconstraints of the parallelogram formed by the second plurality offlexible control links and maintains the same orientation as the basemember 22.

While the second plurality of flexible control links 104, 106, 108 and110 have been shown as being connected between the base member 22 andthe end member 26, it is only necessary that the proximal ends of thesecond plurality of flexible control links be fixed to some referencepoint. Thus, for example, they need not be connected to the base member22 but could alternatively be connected to some other fixed structurelocated in the proximal direction away from the base member 22.

Therefore by rotating gear segments 622, 628, 632, 636, 640 and 644, theend effector can be moved with 5 degrees of freedom and the jaws can beopened and closed. As described below a suitable gear drive mechanismmay be used to drive the gear segments 622, 628, 632, 636, 640 and 644to manipulate the end effector 550 in space to perform an operation.Such operation may be a medical operation for example.

For example, the apparatus described herein may be used in performinglaparoscopic surgery such as shown in FIG. 18 . To do this, there isprovided a movable platform 700 on which is secured a cabinet 702housing a computer 704 either wired or wirelessly connected to acomputer network such as an ethernet network. A gross positioningmechanism shown generally at 706 is connected to the cabinet 702 and hasa head 708 to which the tool controller 602 shown in FIG. 17 isultimately secured. The gross positioning mechanism 706 and the movableplatform 700 allow the head 708 to be positioned at a location in spacesuch that the tool positioning apparatus 20 can be placed inside thepatient's body at a position that allows the desired laparoscopicsurgery to be performed.

Referring to FIG. 19 , to facilitate connection of the tool controller(602) to the head 708 while maintaining a sterile environment, the headis provided with a first portion 712 of a mechanical connector and firstand second pluralities of spaced apart coaxial drive gear segments, onlyone gear segment of each plurality being shown at 710 and 711 in FIG. 19. As will be described below, the first plurality of drive gear segmentscontrols the position of a camera and the second plurality of drive gearsegments controls the tool controller (602). In this embodiment,respective separate motors, only two of which are shown at 714 and 715are provided to independently drive each drive gear in a direction, at aspeed and for a time responsive to control signals received from thecomputer 704 shown in FIG. 18 .

The computer 704 may receive commands from the network to control themotors and a separate computer (shown in FIG. 30 ) connected to an inputdevice controlled by a surgeon performing the surgery may generate thecommands and transmit them on the network in response to hand, fingerand arm movements, for example of the surgeon performing the surgery.The surgeon performing the surgery may be located in the operating roomnear the patient or may be located remotely anywhere in the world.

A coupler 720 comprising a housing 722 and having a second connectorportion 724 of the mechanical connector has a plastic cover 726connected around the perimeter of the housing 722 just below the secondconnector portion 724 of the mechanical connector. Before the secondportion 724 of the mechanical connector is connected to the firstconnector portion 712, the plastic cover 726 is arranged to drapedownwardly such that an open end portion 728 of the plastic cover 726faces downwardly. The coupler 720 is then moved into place such that thesecond connector portion 724 mates with the first connector portion 712as shown in FIG. 20 . Then, referring to FIG. 21 , the plastic cover 726is raised up over the head 708 and onto a portion of the grosspositioning arm 706, leaving only the portion of the coupler 720 belowthe perimeter line at which the plastic cover 726 is attached to thehousing 722, exposed to the patient.

Referring to FIG. 22 , the coupler 720 serves to couple acamera/delivery tube assembly 730 to the head 708 and further serves toconnect one or more tool controllers of the type shown at 602 in FIG. 17to the head 708.

The camera/delivery tube assembly comprises a base 732 having aconnector portion 734 that mates with a corresponding connector portion736 on the coupler 720. A clear plastic delivery tube 738 approximatelyabout 1 inch (2.5 cm) in diameter, about 20 (51 cm) inches long andhaving a wall thickness of about 0.035 (0.1 cm) inches has a proximalend portion 740 connected to the base 732 and has a distal second endportion 742. A camera assembly 748 comprising a camera 750 and a camerapositioner 752 are located at the distal end of the delivery tube and arigid camera positioner support tube 754 extends from the camerapositioner 752 up the delivery tube 738 from the distal second endportion 742 of the delivery tube 738 and is rigidly connected to thebase 732.

Referring to FIG. 23 the camera positioner 752 may be the same as thetool positioner 20 and coupled to a camera controller 760 like the toolcontroller shown at 602 in FIG. 17 to enable the camera 750 to bepositioned on or off the axis 762 of the delivery tube 738. The camera750 need not have the same range of movement as the formerly describedtool positioner 20 and therefore fewer flexible control links may beused in the camera positioner 752. For example, only two of the firstflexible control links may be required to move the camera positioner 752in a vertical direction off-axis of the delivery tube 738 and theflexible control link for rotating the tool may not be required. Thissimplifies the camera controller 760 in that it has fewer spools andgear segments. Only one gear segment is shown at 761 in FIG. 23 butthere are as many gear segments are there are flexible control links forcontrolling the camera position. Referring back to FIG. 19 , each gearsegment is engaged with a corresponding linear gear rack 763 on thecoupler. The linear gear rack 763 on the coupler 720 has a gear portionthat faces upwardly so as to engage with the gear segment 711 on thehead 708 and has a gear portion that faces downwardly to engage with thegear segment 761 shown in FIG. 23 on the camera/delivery tube assembly730.

Referring back to FIG. 19 , the coupler 720 also has a plurality oflinear gear racks having upwardly facing gear portions 765 for engagingcorresponding gear segments 710 on the head 708 and has downwardlyfacing gear portions 767 for engaging corresponding gear segments on atleast one tool controller such as 602 in FIG. 17 , as will be describedbelow.

Referring back to FIG. 23 , the base 732 further has an opticalconnector 770 and an electrical connector 772 that project in a proximaldirection from the base 732 so that when the base is coupled to thecoupling 720 shown in FIG. 22 , they mate with corresponding optical andelectrical connectors 774 and 776 on the head 708. The optical connector774 on the head 708 provides light by way of an optical fiber 778 and acorresponding optical fiber 780 connected to the optical connector 770on the base 732 is routed in the camera positioner and terminates at alocation above a lens 781 on the camera 750 so as to illuminate thesubject of the image taken by the camera 750. The electrical connector772 on the base is connected to the camera 750 to receive image signalsand passes these image signals to the electrical connector 776 on thehead 708, which communicates them to the computer 704 shown in FIG. 18 .The camera 750 may have two lenses or be otherwise configured to produce3D image signals, for example. The computer 704 formats the imagesignals as necessary and transmits them on the network to enable captureof the image signals by devices connected to the network, including adisplay that may be located at or near the input device being operatedby the surgeon.

Referring back to FIG. 23 , the delivery tube 738 has a proximal endportion 782 that extends rearward of the base 732.

Referring to FIG. 24 , the base 732 is shown coupled to the coupler 720,whereupon the gear segments, one of which is shown at 711, forcontrolling the camera positioner 752 engage with the linear gear racks763 on the coupler 720. In addition, the gear segments 710 associatedwith the tool positioner engage with corresponding linear gear racks 765on the coupler 720. A space is provided adjacent the linear gear racks765 to enable at least one tool controller to be mounted in the space ina manner in which the gear segments (628, 622, 632, 636, 640 and 644 ona tool controller 602) are engaged with corresponding linear gear racks,only one of which is shown at 765 in FIG. 24 . Also in the positionshown in FIG. 24 , the optical connectors (770) and (774) and electricalconnectors (772) and (776) are connected to permit light to betransmitted to the camera head and to permit the camera to send imagesignals to the computer 704 in FIG. 18 . Also, when the camera/deliverytube assembly 730 is connected to the coupler 720, the proximal endportion 782 of the delivery tube is disposed adjacent the space adjacentthe linear gear racks 765.

Referring to FIG. 25 , with the camera/delivery tube assembly 730connected to the coupler 720, the tool controller 602 can be installed.Referring to FIG. 26 , to install the tool controller 602, the toolcontroller is positioned such that the tool 550 is inserted into theproximal end portion 782 of the delivery tube (738) and is pushed allthe way through the delivery tube until the tool 550 and tool positioner20 extend outwardly from the distal second end portion 742 of thedelivery tube as shown in FIG. 27 . Thus, the second rigid conduit 606extends inside the delivery tube parallel to the camera positionersupport tube 754 and the tool positioner 20 can be freely moved about inthe space adjacent the distal second end portion 742 of the deliverytube. Referring to FIGS. 26 and 27 , the length of the second rigidconduit 606 is pre-configured so that when the gear segments 628, 622,632, 636, 640 and 644 are engaged with their corresponding linear gearracks (629, 623, 633, 637, 641 and 645), the tool positioner 20 iscompletely outside the delivery tube 738.

Referring to FIG. 26 , in the embodiment shown, the coupler 720 hasfirst and second linear gear rack assemblies 800 and 802 that areoperable to receive first and second tool controllers respectively. Afirst tool controller is shown at 602 and a second tool controller isshown in broken outline at 804. In the above-described design of thefirst tool controller 602 each gear segment 628, 622, 632, 636, 640 and644 has a symmetrically opposite gear segment 928, 922, 932, 936, 940,and 944 on the same hub. These gear segments 928, 922, 932, 936, 940,and 944 lie in respective parallel planes at pre-defined distances froma parallel plane in which the base plate 612 lies and protrude beyond anedge 950 of the base plate 612 by the same amount by which theircorresponding opposite gear segments protrude beyond an opposite edge952 of the base plate 612. In the embodiment shown, the first toolcontroller 602 is installed on the coupler 720 to cooperate with thefirst linear gear rack assembly 800 and when installed to effect thiscooperation, edge 952 of the first tool controller 602 is facing thefirst linear gear rack assembly 800.

The second tool controller 804 is the same as the first tool controller602 but is installed in a mirror image orientation relative to the firsttool controller 602 as shown in broken outline in FIG. 26 . In thisorientation, an edge 954 of the second tool controller 804 correspondingto edge 950 of the first tool controller 602 faces the second lineargear rack assembly 802 and gear segments (equivalent to 928, 922, 932,936, 940, and 944 of the first tool controller 602) of the second toolcontroller 804 engage with corresponding linear gear racks of the secondlinear gear rack assembly 802. Thus, a second tool positioner 812connected to a second tool controller 804 may be fed through thedelivery tube 738 to extend outside the delivery tube as shown in FIG.28 .

Referring to FIG. 29 , with the above described components connectedtogether as described, the laparoscopic surgical apparatus shown in FIG.18 is further described. The movable platform 700 can be used to movethe head 708 into a position such as shown, wherein the tools 550 and810 and camera 750 are positioned inside a patient (not shown) through asingle, relatively small incision. Initially, the camera 750 and firstand second tool positioners are positioned so as to be closely adjacenteach other within the diameter of the delivery tube 738 to facilitateinserting the camera and first and second tool positioners 20 and 812and tools 550 and 810 thereon into the patient through the smallincision. Then the patient can be inflated with CO2 in the conventionalmanner and then the camera can be positioned off-axis of the deliverytube, upwardly, for example and positioned to have a field of view thatencompasses the locations of the tools 550 and 810, for example. Thecamera 750 may also have zoom capability to zoom in on any area ofparticular interest inside the patient in the vicinity of the tools 550and 810. Then, the tools 550 and 810 may be positioned and manipulatedto perform surgery while the actions of the tools are viewed by thecamera 750.

The positioning and manipulation of the tools 550 and 810 is directed bya surgeon operating a workstation such as shown at 860 in FIG. 30 ,having a 3D portal 862, for example, for viewing three-dimensionalimages produced by the camera 750 on a screen and having left and rightinput devices 864 and 866, a handrest 868 and a support cabinet 870mounted on a movable platform 872. The movable platform may have firstand second footswitches 874 and 876. The support cabinet 870 may includea computer 878 operably configured to receive signals from the left andright input devices 864 and 866 and from the first and secondfootswitches 874 and 876 and to produce and transmit command signals onthe network to the computer of the laparoscopic surgical apparatus 850shown in FIG. 29 to cause the liner gear racks to move in directions anddistances that will effect a desired movement of the tool.

Above it was mentioned that the end effector or tool can be moved with 5degrees of freedom by pulling or pushing on various links of the first,second and/or third pluralities of flexible control links 88, 90, 92,94, 104, 106, 108, 110, 120, 122, 124, 126 by moving corresponding onesof the linear gear rack assemblies. A 6th degree of freedom of movementis provided by causing the tool assembly 600 and the tool controller 602to move in a direction along the axis of the second rigid conduit 604.Such motion may be provided by moving the head 708 in a linear directionalong a line coincident with the delivery tube 738, for example.

Alternatively, referring to FIGS. 26 and 31 , in an alternativeembodiment of the coupler 720 the first and second linear gear rackassemblies 800 and 802 can be formed on separate bases 900 and 902 andthe cooperating gear racks (765 on the coupler 720) can be made longenough to permit the first and second linear gear racks 800 and 802 tobe moved linearly relative to a base 904 of the coupler 720 to provide a6th degree of freedom of movement in the direction of the axis of thedelivery tube 738. To affect this movement, the base 904 can be providedwith first and second gear racks 906 and 908 that engage withcorresponding linear gear segments (not shown) on undersides of thefirst and second bases 900 and 902. The first and second gear racks canbe actuated by corresponding mating gear racks (not shown) on the head(708) in a manner similar to that described in connection with the wayindividual racks of the first and second linear gear rack assemblies 800and 802 are actuated.

In the alternative embodiment of the coupler 720 shown in FIG. 31 ,referring to FIG. 32 , when the first and second tool controllers 602and 804 are disposed at different distances from the proximal endportion 782 of the delivery tube, the respective tool positioners 20 and812 are disposed at different distances from the distal end portion 742of the delivery tube which positions the respective tools 550 and 810 atdifferent distances from the distal end portion of the delivery tube.

Advantageously, the apparatus described herein provides for differenttypes of tools to be held by the same type of tool positioning apparatuswhich separates the tool positioning function from the tool operationfunction. Thus, a single type of tool positioner can be provided anddifferent types of tools can selectively be used in that toolpositioning apparatus, as desired. In addition, the apparatus providesfor left and right surgical tools to be received through the sameincision in the patient and allows these tools to be positioned onopposite sides of an axis defined by the delivery tube. This enablesaccess to the area in which surgery is taking place from either side,making it seem to the surgeon quite like directly performing the surgeryin the conventional manner. In addition the same tools that are beingused to perform the functions of the end effector are rotatable abouttheir longitudinal axes which provides for more convenient andindependent positioning of the end effectors.

While specific embodiments of the invention have been described andillustrated, such embodiments should be considered illustrative of theinvention only and not as limiting the invention as construed inaccordance with the accompanying claims.

The invention claimed is:
 1. A laparoscopic surgical apparatus for performing a surgical procedure through a single incision in a patient's body, the apparatus comprising: a gross positioning arm supported on a moveable platform, the gross positioning arm including a head having: at least a first motor; a first gear segment being drivable by the first motor to actuate a tool to perform surgical operations; at least a second motor; and a second gear segment being drivable by the second motor to actuate the tool to perform additional surgical operations, wherein the first gear segment and the second gear segment are spaced apart and coaxial with one another; at least one articulated tool positioning apparatus coupled via a tool controller to an underside of the head, the articulated tool positioning apparatus being configured to receive the tool and couple the tool to the first gear segment and the second gear segment of the head, the tool controller being actuated by the head to cause movements of the at least one articulated tool positioning apparatus for performing surgical operations; and wherein the gross positioning arm is configured to permit the head to be positioned to facilitate insertion of the at least one articulated tool positioning apparatus through the incision into the patient's body.
 2. The apparatus of claim 1 wherein the gross positioning arm is supported on a mobile platform and wherein the head is at least in part positioned by maneuvering the mobile platform to position the head to facilitate insertion of the at least one articulated tool positioning apparatus through the incision into the patient's body.
 3. The apparatus of claim 2 wherein the patient is supported on a surgical table during the surgical procedure and wherein the mobile platform, once maneuvered into position, is coupled to the surgical table.
 4. The apparatus of claim 2 wherein once positioned, the head remains in a fixed location with respect to the patient during the surgical procedure.
 5. The apparatus of claim 1 wherein the at least one articulated tool positioning apparatus has a portion enclosed by a delivery tube, the delivery tube being coupled to an underside of the head and having a distal end, the delivery tube being configured to receive the at least one articulated tool positioning apparatus through the delivery tube such that the tool protrudes beyond the distal end of the delivery tube.
 6. The apparatus of claim 1 wherein the head of the gross positioning arm includes: an optical connector for selective connection with a camera assembly extending through a tube assembly; and an electrical connector for selective connection with the camera assembly.
 7. The apparatus of claim 1 wherein the head includes a plurality of first motor and second motor pairs, wherein each motor pair cooperates to actuate the tool connected to the head.
 8. The apparatus of claim 5 wherein the delivery tube has a proximal end which permits the loading of the at least one articulated tool positioning apparatus and tool controller from behind the head for facilitating loading from a location that is removed from the patient.
 9. The apparatus of claim 6 wherein the delivery tube comprises a connector portion and wherein the head comprises a coupler portion including a corresponding connector portion for removably coupling the delivery tube to the head.
 10. The apparatus of claim 9 wherein the delivery tube when connected via the connector to the connector of the head, causes the tool controller to be coupled for actuation by the head to move the at least one articulated tool positioning apparatus.
 11. A laparoscopic surgical apparatus for performing a surgical procedure through a single incision in a patient's body, the apparatus comprising: a head including: at least a first motor; a first gear segment being drivable by the first motor to actuate a tool to perform surgical operations; at least a second motor; and a second gear segment being drivable by the second motor to actuate the tool to perform additional surgical operations, wherein the first gear segment and the second gear segment are spaced apart and coaxial with one another; an articulated tool positioning apparatus coupled via a tool controller to an underside of the head, the articulated tool positioning apparatus being configured to receive the tool and couple the tool to the first gear segment and the second gear segment of the head, the tool controller being actuated by the head to cause movements of the articulated tool positioning apparatus for performing surgical operations; and wherein the articulated tool positioning apparatus has a portion enclosed by a delivery tube, the delivery tube being coupled to an underside of the head and having a distal end, the delivery tube being configured to receive the articulated tool positioning apparatus through the delivery tube such that the tool protrudes beyond the distal end of the delivery tube.
 12. The apparatus of claim 1 wherein the head comprises a coupler portion for coupling to the tool controller and wherein the coupler portion includes a sterile cover removably connected about a periphery of the coupler portion.
 13. The apparatus of claim 12 wherein the sterile cover has an open end that initially drapes downwardly while connecting a sterile tool controller and at least one articulated tool positioning apparatus to the coupler portion, and wherein following connecting of the sterile tool controller and the at least one articulated tool positioning apparatus, the sterile cover is configured to be raised over the head and a distal portion of the gross positioning arm to provide a sterile barrier between the head and the distal portion of the gross positioning arm and the patient.
 14. The apparatus of claim 11 wherein the head includes a plurality of first motor and second motor pairs, wherein each motor pair cooperates to actuate the tool connected to the head.
 15. The apparatus of claim 11 wherein the delivery tube is sized to receive more than one articulated tool positioning apparatus.
 16. The apparatus of claim 11 wherein the delivery tube is sized to receive a camera, the camera being positionable inside a patient through the single incision to provide a view that encompasses locations of the tool within the patient.
 17. The apparatus of claim 11 wherein the delivery tube is coupled to an underside of the head and wherein the delivery tube has a proximal end which permits the loading of the articulated tool positioning apparatus and tool controller from behind the head for facilitating loading from a location removed from the patient.
 18. The apparatus of claim 11 wherein the delivery tube comprises a connector portion and wherein the head comprises a coupler portion including a corresponding connector portion for removably coupling the delivery tube to the head.
 19. The apparatus of claim 11 wherein the delivery tube when connected to the head, causes the tool controller to be coupled for actuation by the head to move the articulated tool positioning apparatus.
 20. The apparatus of claim 11 wherein the head is included on a gross positioning arm, and wherein the head includes: an optical connector for selective connection with a camera assembly extending through a tube assembly; and an electrical connector for selective connection with the camera assembly. 